Posted by SLS on September 1, 2009, at 5:45:12
In reply to Re: How did the appt. go?, posted by g_g_g_unit on September 1, 2009, at 0:10:07
> i am curious about the conservative dosing regime: 20mg at first, and then 30mg if that proves insufficient.
It is conservative. For most moderate to severe cases of MDD or BD, 40mg seems to be the minimum dosage that one will respond to. How long is it until you see the doctor next?
> is there even much MAO inhibition at 20mg?
Not enough to be consequential.
I had to suffer through a protracted trial of desipramine because my doctor was unfamiliar with adding it to Parnate, and he was still afraid of Parnate and its potential to produce spontaneous hypertensive events. I could have arrived at my therapeutic dose (300mg) within two weeks. It took over two months to get to where I needed to be under his supervision. I can't blame him though. Were I in his position, I probably would have been conservative, too.
Perhaps you can use a negotiating tool. Show him stuff regarding the safe and effective use of Parnate at dosages of 120mg and higher. Maybe he'll meet you half-way. :-)
- Scott
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1: Pharmacopsychiatry. 1989 Jan;22(1):21-5.Links
High dose tranylcypromine therapy for refractory depression.
Amsterdam JD, Berwish NJ.Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia.
A substantial number of depressed patients will experience a chronic, treatment-resistant affective disorder. Aggressive treatment of these patients with various drug combinations, unconventional antidepressants, or electroconvulsive therapy has met with only partial success. There remains a pressing need to identify more effective methods of utilizing "first-line" antidepressant agents to achieve a more rapid therapeutic action. To this end, we initiated a study using high doses of the MAO inhibitor tranylcypromine, at a range of 90 mg to 170 mg daily, in seven refractory depressed patients who had failed to respond to at least three prior treatments regimens. Four out of seven subjects (57%), who had failed to respond to a mean of 8 +/- 5 prior treatment, had a complete response, and one patient had a partial response to high dose tranylcypromine. The mean SD maximum tranylcypromine dose for the responders was 112 +/- 16 mg daily (range 90 mg to 130 mg). Response did not appear to be a function of severity of illness, duration of present episode, or the number of prior treatment failures. Overall, the side effect profile was favorable, and no "cheese reactions" were encountered. These observations are of clinical significance and suggest the need for further controlled studies using high doses of tranylcypromine.
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